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抗糖尿病药物单药治疗患者的健康相关生活质量与医疗事件

Health-Related Quality of Life and Healthcare Events in Patients with Monotherapy of Anti-Diabetes Medications.

作者信息

Abegaz Tadesse Melaku, Ali Askal Ayalew

机构信息

Economic, Social and Administrative Pharmacy (ESAP), College of Pharmacy and Pharmaceutical Sciences, Institute of Public Heath, Florida A&M University, Tallahassee, FL 32307, USA.

出版信息

Healthcare (Basel). 2023 Feb 12;11(4):541. doi: 10.3390/healthcare11040541.

Abstract

This study aimed to examine the difference in health-related quality of life (HRQOL) and diabetes-related healthcare events (HCEs) among adults with diabetes who were on metformin, sulfonylurea, insulin, or thiazolidinedione (TZD) monotherapy. The data were sourced from the Medical Expenditure Panel Survey (MEPS). Diabetes patients ≥18 years old who had a complete record of physical component score and mental component scores in round 2 and round 4 of the survey were included. The primary outcome was HRQOL of diabetes patients as measured by the Medical Outcome Study short-form (SF-12v2). Multinomial logistic regression and negative binomial regression were conducted to determine associated factors of HRQOL and HCE, respectively. Overall, 5387 patients were included for analysis. Nearly 60% of patients had unchanged HRQOL after the follow-up, whereas almost 15% to 20% of patients showed improvement in HRQOL. The relative risk of declined mental HRQOL was 1.5 times higher relative to unchanged mental HRQOL in patients who were on sulfonylurea 1.55 [1.1-2.17, = 0.01] than metformin users. The rate of HCE decreased by a factor of 0.79, [95% CI: 0.63-0.99] in patients with no history of hypertension. Patients on sulfonylurea 1.53 [1.20-1.95, <0.01], insulin 2.00 [1.55-2.70, <0.01], and TZD 1.78 [1.23-2.58, <0.01] had increased risk of HCE compared to patients who were on metformin. In general, antidiabetic medications modestly improved HRQOL in patients with diabetes during the follow-up period. Metformin had a lower rate of HCE as compared to other medications. The selection of anti-diabetes medications should focus on HRQOL in addition to controlling glucose level.

摘要

本研究旨在探讨接受二甲双胍、磺脲类药物、胰岛素或噻唑烷二酮(TZD)单药治疗的成年糖尿病患者在健康相关生活质量(HRQOL)和糖尿病相关医疗事件(HCEs)方面的差异。数据来源于医疗支出面板调查(MEPS)。纳入了年龄≥18岁且在调查第2轮和第4轮中有完整身体成分得分和精神成分得分记录的糖尿病患者。主要结局是通过医学结局研究简表(SF - 12v2)测量的糖尿病患者的HRQOL。分别进行多项逻辑回归和负二项回归以确定HRQOL和HCE的相关因素。总体而言,纳入5387例患者进行分析。随访后近60%的患者HRQOL未改变,而近15%至20%的患者HRQOL有所改善。与二甲双胍使用者相比,使用磺脲类药物1.55 [1.1 - 2.17,P = 0.01]的患者精神HRQOL下降的相对风险是精神HRQOL未改变患者的1.5倍。无高血压病史的患者HCE发生率降低了0.79倍,[95%置信区间:0.63 - 0.99]。与使用二甲双胍的患者相比,使用磺脲类药物1.53 [1.20 - 1.95,P < 0.01]、胰岛素2.00 [1.55 - 2.70,P < 0.01]和TZD 1.78 [1.23 - 2.58,P < 0.01]的患者HCE风险增加。总体而言,在随访期间抗糖尿病药物适度改善了糖尿病患者的HRQOL。与其他药物相比,二甲双胍的HCE发生率较低。抗糖尿病药物的选择除了控制血糖水平外,还应关注HRQOL。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5db8/9957473/29d799ee1be7/healthcare-11-00541-g001.jpg

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